insulin lispro (Humalog, Humalog Kwikpen)

Dosing and uses of Humalog, HumaPen Memoir (insulin lispro)

• Adult
• Pediatric

 

Adult dosage forms and strengths

injectable solution

• 100units/mL (10mL vial)

injectable pen

• 100units/mL (3mL pen or cartridge)
• 200units/mL (3mL pen or cartridge)

 

Type 1 or 2 Diabetes Mellitus

Rapid-acting human insulin analogue indicated to improve glycemic control in adults and children with type 1 or 2 diabetes mellitus

Type 1 diabetes mellitus

• Approximately one third of the total daily insulin requirements SC; rapid-acting or short-acting, premeal insulin should be used to satisfy the remainder of the daily insulin requirements
• Usual daily maintenance range is 0.5-1 unit/kg/day in divided doses; nonobese may require 0.4-0.6 unit/kg/day; obese may require 0.8-1.2 units/kg/day

Type 2 diabetes mellitus

• Type 2 diabetes mellitus inadequately controlled with oral medication
• 10 units/day SC (or 0.1-0.2 unit/kg/day) of intermediate- or long-acting insulin given at bedtime generally recommended; as an alternative, rapid-acting formulations, such as insulin lispro, given before meals have also been used; dose must be adjusted carefully.

 

Dosing Considerations

When given subcutaneously, insulin lispro has a more rapid onset of action and a shorter duration of action than regular human insulin

Dosage must be individualized; blood glucose monitoring is essential in all patients receiving insulin therapy

Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs

Humalog U200 not for IV administration

Humalog U-200 with not for mixing with any other insulins

Do NOT perform dose conversion when using either the Humalog U-100 or U-200 KwikPens; the dose window shows number of insulin units to be delivered and no conversion is needed

SC injection

• Do NOT transfer Humalog U-200 from the KwikPen to a syringe for administration; the markings on the insulin syringe will not measure the dose correctly and can result in overdosage and severe hypoglycemia
• Administer within 15 minutes before a meal or immediately after a meal
• When administered by SC injection, insulin lispro should generally be used in regimens with an intermediate- or long-acting insulin
• Administered by SC injection in the abdominal wall, thigh, or upper arm
• Injection sites should be rotated within the same region (abdomen, thigh or upper arm) from one injection to the next to reduce the risk of lipodystrophy
• Humalog U200 not for IV administration

Continuous SC injection (insulin pump)

• May be administered by continuous SC infusion in the abdominal wall
• Do not use diluted or mixed insulins in external insulin pumps
• Infusion sites should be rotated within the same region to reduce the risk of lipodystrophy
• Continuous subcutaneous infusion pump (i.e., insulin pump) not for Humalog U-200 administration; Humalog U-100 only
• Initial programming of the external insulin infusion pump should be based on the total daily insulin dose of the previous regimen

 

Pediatric dosage forms and strengths

injectable solution

• 100units/mL (10mL vial)

injectable pen

• 100units/mL (3mL pen or cartridge)
• 200units/mL (3mL pen or cartridge)

 

Type I Diabetes Mellitus

Rapid-acting human insulin analogue indicated to improve glycemic control in adults and children with diabetes mellitus

<3 years: Safety and efficacy not established

≥3 years: May require 0.8-1.2 units/kg/day SC during growth spurts; otherwise, use adult dosing (0.5-1 unit/kg/day)

 

Dosing Considerations

Approved for use in children aged ≥3 yr for SC daily injections and for SC continuous infusion by external insulin pump

Do NOT perform dose conversion when using either the Humalog U-100 or U-200 KwikPens; the dose window shows number of insulin units to be delivered and no conversion is needed

Humalog U-200 with not for mixing with any other insulins

Dosage of human insulin, which is always expressed in USP units, must be based on the results of blood and urine glucose tests and must be carefully individualized to optimal effect

Continuous SC injection (insulin pump)

• May be administered by continuous SC infusion in the abdominal wall
• Humalog U200 not for IV administration
• Do not use diluted or mixed insulins in external insulin pumps
• Infusion sites should be rotated within the same region to reduce the risk of lipodystrophy
• Initial programming of the external insulin infusion pump should be based on the total daily insulin dose of the previous regimen
• Continuous subcutaneous infusion pump (i.e., insulin pump) not for Humalog U-200 administration; Humalog U-100 only

 

Humalog, HumaPen Memoir (insulin lispro) adverse (side) effects

Frequency not defined

Hypoglycemia

Pallor

Palpitation

Redness

Hunger

Nausea

Tachycardia

Lipodystrophy

Lipohypertrophy

Local allergic reaction

Hypokalemia

 

Warnings

Contraindications

During episodes of hypoglycemia

Systemic allergic reactions

 

Cautions

Never share a pen between patients even if the needle is changed

Adjust dosage and monitoring when medically warranted

Decreased insulin requirements (eg, diarrhea, nausea, vomiting, malabsorption, hypothyroidism, renal impairment, hepatic impairment)

Increased insulin requirements (eg, fever, hyperthyroidism, trauma, infection, surgery)

Hypoglycemia is the most common adverse reaction

May cause a shift in potassium from extracellular to intracellular space, possibly leading to hypokalemia; caution when coadministered with potassium-lowering drugs or conditions that may decrease potassium

Frequent glucose monitoring and insulin dose reduction may be required with renal or hepatic impairment

Do not mix SC injection with insulin preparations other than NPH insulin

Do not mix IV or continuous SC infusions with any other insulins

Do NOT transfer Humalog U-200 from the KwikPen to a syringe for administration; the markings on the insulin syringe will not measure the dose correctly and can result in overdosage and severe hypoglycemia

Do NOT perform dose conversion when using either the Humalog U-100 or U-200 KwikPens; the dose window shows number of insulin units to be delivered and no conversion is needed

Do NOT mix Humalog U-200 with any other insulins

Do NOT administer Humalog U-200 using a continuous subcutaneous infusion pump (i.e., insulin pump); insulin pump is to be used only for Humalog U-100

Do NOT administer Humalog U200 intravenously

Pregnancy

Thiazolidinediones are peroxisome proliferator-activated receptor (PPAR)-gamma agonists and can cause dose-related fluid retention, particularly when used in combination with insulin; fluid retention may lead to or exacerbate heart failure; monitor for signs and symptoms of heart failure, treat accordingly, and consider discontinuing thiazolidinediones

 

Pregnancy and lactation

Pregnancy category: B

Lactation: Considered safe for use during breastfeeding

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Humalog, HumaPen Memoir (insulin lispro)

Mechanism of action

Protein hormone; stimulates glucose uptake by peripheral cells

Regulates glucose metabolism; insulins lower blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat and by inhibiting hepatic glucose production. Insulins inhibit lipolysis and proteolysis and enhance protein synthesis; targets include skeletal muscle, liver, and adipose tissue

 

Absorption

Bioavailability: 55-77% following SC; well absorbed

Onset: 0.5-5 hr (initial); 0.5-2.5 hr

Duration of action: ≤5 hr

Peak plasma time: 0.5-1.5 hr

 

Distribution

Vd: 0.26-0.36 L/kg

 

Metabolism

Liver (>50%); kidney (30%); adipose tissue/muscle (20%)

 

Elimination

Half-life: 1 hr (SC); 0.5-1 hr (IV); dose dependent